Tsivgoulis Georgios, Psaltopoulou Theodora, Wadley Virginia G, Alexandrov Andrei V, Howard George, Unverzagt Frederick W, Moy Claudia, Howard Virginia J, Kissela Brett, Judd Suzanne E
From the Second Department of Neurology, Attikon Hospital (G.T.) and Department of Hygiene, Epidemiology and Medical Statistics (T.P.), University of Athens School of Medicine, Athens, Greece; Department of Neurology, The University of Tennessee Health Science Center, Memphis, TN (G.T., A.V.A.); International Clinical Research Center, St. Anne's University Hospital in Brno, Czech Republic (G.T.); Department of Medicine (V.G.W.), Department of Biostatistics, School of Public Health (G.H., S.E.J.), and Department of Epidemiology, School of Public Health (V.J.H.), University of Alabama at Birmingham; Department of Psychiatry, Indiana University School of Medicine, Indianapolis (F.W.U.); National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD (C.M.); and Department of Neurology, University of Cincinnati, OH (B.K.).
Stroke. 2015 Mar;46(3):780-5. doi: 10.1161/STROKEAHA.114.007894. Epub 2015 Jan 27.
There are limited data on the potential association of adherence to Mediterranean diet (MeD) with incident stroke. We sought to assess the longitudinal association between greater adherence to MeD and risk of incident stroke.
We prospectively evaluated a population-based cohort of 30 239 individuals enrolled in REasons for Geographic and Racial Differences in Stroke (REGARDS) study, after excluding participants with stroke history, missing demographic data or food frequency questionnaires, and unavailable follow-up information. Adherence to MeD was categorized using MeD score. Incident stroke was adjudicated by expert panel review of medical records during a mean follow-up period of 6.5 years.
Incident stroke was identified in 565 participants (2.8%; 497 and 68 cases of ischemic stroke [IS] and hemorrhagic stroke, respectively) of 20 197 individuals fulfilling the inclusion criteria. High adherence to MeD (MeD score, 5-9) was associated with lower risk of incident IS in unadjusted analyses (hazard ratio, 0.83; 95% confidence interval, 0.70-1.00; P=0.046). The former association retained its significance (hazard ratio, 0.79; 95% confidence interval, 0.65-0.96; P=0.016) after adjustment for demographics, vascular risk factors, blood pressure levels, and antihypertensive medications. When MeD was evaluated as a continuous variable, a 1-point increase in MeD score was independently associated with a 5% reduction in the risk of incident IS (95% confidence interval, 0-11%). We documented no association of adherence to MeD with incident hemorrhagic stroke. There was no interaction of race (P=0.37) on the association of adherence to MeD with incident IS.
High adherence to MeD seems to be associated with a lower risk of incident IS independent of potential confounders. Adherence to MeD is not related to the risk of incident hemorrhagic stroke.
关于坚持地中海饮食（MeD）与新发中风之间潜在关联的数据有限。我们旨在评估更高程度坚持MeD与新发中风风险之间的纵向关联。
我们对参加中风地理和种族差异原因（REGARDS）研究的30239名基于人群的队列进行了前瞻性评估，排除了有中风病史、人口统计学数据缺失或食物频率问卷缺失以及随访信息不可用的参与者。使用MeD评分对坚持MeD的情况进行分类。在平均6.5年的随访期内，由专家小组对医疗记录进行审查来判定新发中风。
在符合纳入标准的20197名个体中，有565名参与者（2.8%；分别有497例和68例缺血性中风[IS]和出血性中风）被确定为新发中风。在未调整的分析中，高度坚持MeD（MeD评分，5 - 9）与较低的新发IS风险相关（风险比，0.83；95%置信区间，0.70 - 1.00；P = 0.046）。在对人口统计学、血管危险因素、血压水平和抗高血压药物进行调整后，前者的关联仍具有显著性（风险比，0.79；95%置信区间，0.65 - 0.96；P = 0.016）。当将MeD作为连续变量进行评估时，MeD评分每增加1分与新发IS风险降低5%独立相关（95%置信区间，0 - 11%）。我们记录到坚持MeD与新发出血性中风之间无关联。在坚持MeD与新发IS的关联上，种族无交互作用（P = 0.37）。
高度坚持MeD似乎与较低的新发IS风险相关，且独立于潜在混杂因素。坚持MeD与新发出血性中风风险无关。
